Tag Archives: Mediterranean Diet

July 15, 2010 · 10:01 AM

Maybe Diet Prevents Alzheimer Dementia After All

I blogged about a study by Gu et al on April 30, 2010, that found significantly lower incidence of Alzheimer dementia in people in Manhattan who followed this dietary pattern:

  • relatively high consumption of salad dressing, nuts, fish, tomatoes, fruits, dark green leafy vegetables, and cruciferous  vegetables
  • relatively low consumption of poultry, red meat, butter, and high-fat dairy

About the same time, a National Institutes of Health expert panel pooh-poohed the possibility that diet had any effect one way or the other on Alzheimer’s. 

Why does this matter?  Five million U.S. adults have Alzheimer dementia already, and it’s going to get much worse over the coming decades.

A June, 2010, issue of Journal of the American Medical Association has a commentary by two doctors (Martha Morris, Sc.D., and Christine Tangney, Ph.D.), experts in the field of nutrition.  Here’s their explanation of the NIH panel’s negative findings:

Many of the inconsistencies among studies of dietary factors can be attributed to the complexity of nutrition science and the omission of nutrition expertise in the design and analysis of both epidemiological and randomized controlled trials.

Morris and Tangney think the findings of Gu et al are valid, confirming prior studies showing benefit to diets high in vitamin E (from food) and low in saturated fat from animals.  They point out that the animal foods may simply be displacing beneficial nutrients in other foods, rather than directly causing harm.

Until we have further data, anyone at risk for Alzhiemer’s may be better off following the dietary pattern above, or the Mediterranean diet.  The two are similar.

Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physican before making any dietary or exercise changes. 

Reference: Morris, M., & Tangney, C.  Diet and Prevention of Alzheimer Disease.  The Journal of the American Medical Association, 303 (2010): 2,519-2,520.    doi: 10.1001/jama.2010.844

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July 2, 2010 · 2:00 AM

Basic Science: Mediterranean Diet Boosts Antioxidant Power

Compared to the low-fat American Heart Association diet, the traditional Mediterranean diet rich in olive oil has more capacity to counteract potentially harmful “free radicals” and “reactive oxygen species” in our bodies, according to researchers at the University of Navarra in Spain.

Our tissues normally contain free radicals and reactive oxygen species, which are intrinsic to cell metabolism.  They serve useful purposes.  In excessive amounts, however, many believe they cause “oxidative damage” and thereby contribute to chronic degenerative conditions such as atherosclerosis, aging, dementia, and cancer.

Antioxidants are thought to neutralize free radicals and reactive oxygen species, which may lead to better health.

The PREDIMED study is an ongoing Spanish project testing the heart-protective effects of the Mediterranean diet in high-risk people over the course of four years.  The three intervention groups are 1) Medi diet plus supplemental virgin olive oil, 2) Medi diet plus extra tree nuts, and 3) low-fat American Heart Association diet.

After three years of follow-up, the researchers measured “total antioxidant capacity” in the bloodstream of a subset of the PREDIMED participants.

They found that the two Mediterranean diet groups had significantly greater total antioxidant capacity, about 50% more than the low-fat control group.  Within the Medi + olive oil group, the participants with the highest levels of antioxidant capacity actually tended to lose weight, an association not seen in the other groups.

The Researchers’ Conclusions

Mediterranean diet, especially rich in virgin olive oil, is associatied with higher levels of plasma antioxidant capactiy.  Plasma total antioxidant capacity is related to a reduction in body weight after three years of intervention in a high cardiovascular risk population with a Mediterranean-style diet rich in virgin olive oil.

In other words, the Mediterranean diet with virgin olive oil may help you keep your weight under control, and the antioxidant capacity may contribute to the well-documented health benefits of the diet.

Steve Parker, M.D.

PS:  It’s impossible to tell from this report just how much weight loss was seen in the high-TAC Medi+olive oil subjects.  I doubt it was much.  Baseline body mass index for all participants was around 29, so they were overweight and just a shade under obese.

PPS:  Both the Ketogenic Mediterranean and Diabetic Mediterranean Diets mandate minimal amounts of olive oil consumption, with no upper limit.

Reference: Razquin, C., et al. A 3 year follow-up of a Mediterranean diet rich in virgin olive oil is associated with high plasma antioxidant capacity and reduced body weight gain.  European Journal of Clinical Nutrition, 63 (2009): 1,387-1,393.  doi 10.1038/ejcn.2009.106

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June 30, 2010 · 2:00 AM

Cancer and Diabetes: Any Connection?

ResearchBlogging.orgType 2 diabetes is associated with higher incidence of several cancers: liver, pancreas, uterus, colo-rectal, breast, and bladder.  On a brighter note, diabetics have lower risk of prostate cancer.

That’s about all we know for sure, according to a report from an expert panel convened by the American Diabetes Association and the American Cancer Society and published recently in CA: A Cancer Journal for Clinicians.

The report is focused on type 2 diabetes simply because 95% of all worldwide cases of diabetes are type 2; we have much more data.  [Type 1 diabetes, you may recall, has onset much earlier  in life and is fatal if not treated with insulin injections.  The type 1 pancreas produces no insulin.]

This report is a good summary of all we know about the cancer/diabetes connection in 2010.  What we don’t know far outweighs what we do know.

Does optimal treatment of diabetes reduce cancer risk?  Do particular diabetic medications raise or lower the risk of cancer?  If an overweight diabetic loses excess weight, does the risk of cancer diminish?  Sorry, we don’t know.

In men, 25% of all invasive cancers in the U.S. will be prostate cancer.  In women, breast cancer is the leader, comprising 26% of all cancers.  [Common skin cancers are rarely invasive or fatal and are not included in these statistics.  Melanoma, on the other hand, is invasive.]

The lifetime probability of an individual developing invasive cancer in the U.S. is about 4 in 10 (40%).  A little higher in men (45%), a little lower in women (38%).  The American Cancer Society projected 565,650 deaths from cancer in 2008.  If we look at deaths of people under 85, cancer kills more people than heart disease.

The traditional Mediterranean diet is associated with lower risk of prostate, breast, colon, and uterus cancer.  Three of these, you’ll note, are seen at higher rates in diabetics.

Lack of regular exercise is associated with higher cancer rates. 

If I were a type 2 diabetic wanting to reduce my risk of cancer, I’d be sure to exercise regularly, keep my body mass index under 30 (if not lower), refrain from smoking, consider a Mediterranean-style diet, and ask my doctor to monitor for onset of cancer.

Steve Parker, M.D.

Reference: Giovannucci, E., Harlan, D., Archer, M., Bergenstal, R., Gapstur, S., Habel, L., Pollak, M., Regensteiner, J., & Yee, D. (2010). Diabetes and Cancer: A Consensus Report CA: A Cancer Journal for Clinicians DOI: 10.3322/caac.20078

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June 28, 2010 · 2:00 AM

MSDP Protects Against MetSyn (NCEP ATP-III Criteria) in FHSOC

ResearchBlogging.orgTranslation:  A Mediterranean-style dietary pattern protected against onset of metabolic syndrome (as defined by National Cholesterol Education Program Adult Treatment Panel III) in the Framingham Heart Study Offspring Cohort.

Made you look! 

Don’t you just love acronyms?  Lately it seems you gotta have a clever acronym for your scientific study or it won’t get published or remembered. 

Metabolic syndrome is a constellation of clinical traits that are associated with increased risk for developing cardiovascular disease (two-fold increased risk) and type 2 diabetes (six-fold increased risk).  It’squite common—about 47 million in the U.S. have it.  Metabolic syndrome features include insulin resistance, large waist circumference, low HDL cholesterol, elevated fasting blood sugar, high triglycerides, and elevated blood pressure. 

For optimal health, you want to avoid metabolic syndrome.

Boston-based researchers reported in American Journal of Clinical Nutrition last December that followers of the the Mediterranean diet had less risk of developing metabolic syndrome; not by much, but it was statistically significant.  The study population was the Framingham (Massachusetts) Heart Study Offspring Cohort.

Several thousand men and women were studied via food frequency questionnaires, lab work, and physical exams.  Adherence to the Mediterranean diet was measured via a calculated score ranging from zero to 100.  No diabetics were enrolled.  Average age was 54.  Follow-up time averaged seven years.

They found that those adhering closely to the Mediterranean diet had fewer metabolic syndrome traits at baseline: less insulin resistance, lower waist size,  lower fasting blood sugar, lower triglycerides, and higher HDL cholesterol levels.

Not only that, the Mediterranean dieters developed less metabolic syndrome over time.  Over seven years, 38% of the folks with least compliance to the Mediterranean diet developed metabolic syndrome.  Of those with highest adherence, only 30% developed it.

This is the first study to show a prospective association between the Mediterranean diet and improved insulin resistance.  Avoiding insulin resistance is a good thing, and may help explain the Spanish study that found lower incidence of type 2 diabetes in Mediterranean diet followers.

Why didn’t the investigators report on the incidence of diabetes that developed over the course of the study?  Surely some of these folks developed diabetes.  Are they saving that for another report?  “Publish or perish,” you know.

You can start to see why the Mediterranean diet has a reputation as one of the healthiest around. 

It would be interesting to score these study participants with a very low-carb diet score (VLCDS—yeah, baby!).  Such diets are associated with lower blood pressure, lower blood sugars, lower triglycerides, and higher HDL cholesterol.  Like Mediterranean diet followers, I bet low-carbers would demonstrate lower prevalence of metabolic syndrome at baseline and lower incidence over time. 

Reference: Rumawas, M., Meigs, J., Dwyer, J., McKeown, N., & Jacques, P. (2009). Mediterranean-style dietary pattern, reduced risk of metabolic syndrome traits, and incidence in the Framingham Offspring Cohort American Journal of Clinical Nutrition, 90 (6), 1608-1614 DOI: 10.3945/ajcn.2009.27908

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May 31, 2010 · 6:10 PM

Documented Health Benefits of the Mediterranean Diet

The enduring popularity of the Mediterranean diet is attributable to three things:

  1. Taste
  2. Variety
  3. Health benefits

 For our purposes today, I use “diet” to refer to the usual food and drink of a person, not a weight-loss program.

The scientist most responsible for the popularity of the diet, Ancel Keys, thought the heart-healthy aspects of the diet related to low saturated fat consumption.  He also thought the lower blood cholesterol levels in Mediterranean populations (at least Italy and Greece) had something to do with it, too.  Dietary saturated fat does tend to raise cholesterol levels, both LDL and HDL.

Even if Keys was wrong about saturated fat and cholesterol levels being positively associated with heart disease, numerous studies (involving eight countries on three continents) strongly suggest that the Mediterranean diet is one of the healthiest around.  See References below for the most recent studies.

Relatively strong evidence supports the Mediterranean diet’s association with:

■ increased lifespan

■ lower rates of cardiovascular disease such as heart attacks and strokes

■ lower rates of cancer (prostate, breast, uterus, colon)

■ lower rates of dementia

■ lower incidence of type 2 diabetes

 

Weaker supporting evidence links the Mediterranean diet with:

■ slowed progression of dementia

■ prevention of cutaneous melanoma

■ lower severity of type 2 diabetes, as judged by diabetic drug usage and fasting blood sugars

■ less risk of developing obesity

■ better blood pressure control in the elderly

■ improved weight loss and weight control in type 2 diabetics

■ improved control of asthma

■  reduced risk of developing diabetes after a heart attack

■ reduced risk of mild cognitive impairment

■  prolonged life of Alzheimer disease patients

■ lower rates and severity of chronic obstructive pulmonary disease

■ lower risk of gastric (stomach) cancer

■ less risk of macular degeneration

■ less Parkinsons disease

■ increased chance of pregnancy in women undergoing fertility treatment

■  reduced prevalence of metabolic syndrome (when supplemented with nuts)

■ lower incidence of asthma and allergy-like symptoms in children of women who followed the Mediterranean diet while pregnant

Did you notice that I used the word “association” in relating the Mediterranean diet to health outcomes?  Association, of course, is not causation. 

The way to prove that a particular diet is healthier is to take 20,000 similar young adults, randomize the individuals  in an interventional study to eat one of two test diets for the next 60 years, monitoring them for the development of various diseases and death.  Make sure they stay on the assigned test diet.  Then you’d have an answer for that population and those two diets.  Then you have to compare the winning diet to yet other diets.  And a study done in Caucasians would not necessarily apply to Asians, Native Americans, Blacks, or Hispanics.

Now you begin to see why scientists tend to rely on observational  rather than interventional diet studies.

I became quite interested in nutrition around the turn of the century as my patients asked me for dietary advice to help them lose weight and control or prevent various diseases.  At that time, the Atkins diet, Mediterranean diet, and Dr. Dean Ornish’s vegetarian program for heart patients were all prevalent.  And you couldn’t pick three programs with more differences!  So I had my work cut out for me. 

After much scientific literature review, I find the Mediterranean diet to be the healthiest for the general population.  People with particular medical problems or ethnicities may do better on another diet.  A low-carb Mediterranean diet should be healthier for type 2 diabetics.  Dan Buettner makes a good argument for plant-based diets in his longevity book, The Blue Zones.  The traditional Mediterranean diet qualifies as plant-based.

What do you consider the overall healthiest diet, and why?

Steve Parker, M.D.

References:

Buckland, Genevieve, et al.  Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study.  American Journal of Clinical Nutrition, December 9, 2009, epub ahead of print.  doi: 10.3945/ajcn.2009.28209

Fortes, C., et al.  A protective effect of the Mediterraenan diet for cutaneous melanoma.  International Journal of Epidmiology, 37 (2008): 1,018-1,029.

Sofi, Francesco, et al.  Adherence to Mediterranean diet and health status: Meta-analysis.  British Medical Journal, 337; a1344.  Published online September 11, 2008.  doi:10.1136/bmj.a1344

Benetou, V., et al.  Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort.  British Journal of Cancer, 99 (2008): 191-195.

Mitrou, Panagiota N., et al.  Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population,  Archives of Internal Medicine, 167 (2007): 2461-2468.

Feart, Catherine, et al.  Adherence to a Mediterranean diet, cognitive decline, and risk of dementia.  Journal of the American Medical Association, 302 (2009): 638-648.

Scarmeas, Nikolaos, et al.  Physical activity, diet, and risk of Alzheimer Disease.  Journal of the American Medical Association, 302 (2009): 627-637.

Scarmeas, Nikolaos, et al.  Mediterranean Diet and Mild Cognitive Impairment.  Archives of Neurology, 66 (2009): 216-225.

Scarmeas, N., et al.  Mediterranean diet and Alzheimer disease mortality.  Neurology, 69 (2007):1,084-1,093.

Fung, Teresa, et al.  Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women.  Circulation, 119 (2009): 1,093-1,100.

Mente, Andrew, et al.  A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease.  Archives of Internal Medicine, 169 (2009): 659-669.

Salas-Salvado, Jordi, et al.  Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status: One-Year Results of the PREDIMED Randomized Trial.  Archives of Internal Medicine, 168 (2008): 2,449-2,458.

Mozaffarian, Dariush, et al.  Incidence of new-onset diabetes and impaired fasting glucose in patients with recent myocardial infarction and the effect of clinical and lifestyle risk factors.  Lancet, 370 (2007) 667-675.

Esposito, Katherine, et al.  Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes.  Annals of Internal Medicine, 151 (2009): 306-314.

Shai, Iris, et al.  Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet.  New England Journal of Medicine, 359 (2008): 229-241.

Martinez-Gonzalez, M.A., et al.  Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study.  British Medical Journal, BMJ,doi:10.1136/bmj.39561.501007.BE (published online May 29, 2008).

Trichopoulou, Antonia, et al.  Anatomy of health effects of the Mediterranean diet: Greek EPIC prospective cohort study.  British Medical Journal, 338 (2009): b2337.  DOI: 10.1136/bmj.b2337.

Barros, R., et al.  Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma control.  Allergy, vol. 63 (2008): 917-923.

Varraso, Raphaelle, et al.  Prospective study of dietary patterns and chronic obstructive pulmonary disease among US men.  Thorax, vol. 62, (2007): 786-791

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May 31, 2010 · 3:59 PM

Medical Heresy: Mediterranean Diet Causes Heart Attacks

Recent media reports suggest that the Mediterranean diet may actually cause heart attacks in certain individuals.  I attempt to debunk this idea in my May 31, 2010, post at NutritionData’s Heart Health Blog.

The Mediterranean diet has long been associated with lower rates of heart disease.

Steve Parker, M.D.

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May 17, 2010 · 12:22 AM

Low-Carb Mediterranean Diet Improves Glucose Control and Heart Risk Factors in Overweight Diabetics

In overweight type 2 diabetics, a low-carbohydrate Mediterranean diet improved HDL cholesterol levels and glucose control better than either the standard Mediterranean diet or American Diabetes Association diet, according to Israeli researchers reporting earlier this year.

Background

Prior studies suggest that diets rich in monounsaturated fatty acids (olive oil, for example) elevate HDL cholesterol and reduce LDL cholestrol and triglycerides in type 2 diabetics.

Low-carb diets improve blood sugar levels and reduce excess body weight in type 2 diabetics, leading to the ADA’s allowance in 2008 of a low-carbohydrate diet as an alternative to standard diabetic diets.

Many—probably most—type 2 diabetics have insulin resistance:  the body’s cells that can remove sugar from the bloodstream are not very sensitive to the effect of insulin driving sugar into those cells.  They “resist” insulin’s effect.  Consumption of monounsaturated fatty acids  improves insulin sensitivity.  In other words, insulin is better able to push blood sugar into cells, removing it from the bloodstream.

Previous studies have shown that both low-carb diets and the Mediterranean diet reduce after-meal elevations in blood sugar, which likely lowers levels of triglycerides and LDL cholesterol.

How Was the Study Done?

The goal was to compare effects of three diets in overweight type 2 diabetics in Israel over the course of one year.  Study participants totalled 259.  Average age was 56, average weight 86 kg (189 lb), average hemoglobin A1c 8.3%, and average fasting plasma glucose (sugar) was 10.3 mmol/L (185 mg/dl).  [Many diabetics in the U.S. fit this profile.]  People taking insulin were excluded from the study, as were those with proliferative diabetic retinopathy—no reasons given. 

Participants were randomly assigned to one of three diets, so there were about 85 in each group.  [Over the course of one year, people dropped out of the study for various reasons, leaving each group with about 60 subjects.] 

Here are the diets:

  • 2003 ADA (American Diabetes Association) diet:  50-55% of total caloric intake from carbohydrate (mixed glycemic index carbs), 30%  from fat, 20% from protein
  • Traditional Mediterranean (TM):  50-55% low-glycemic-index carbs, 30% fat—high in monounsaturated fat, 15-20% protein
  • Low-carb Mediterranean (LCM) :  35% low-glycemic-index carbs, 45% fat—high in monounsaturated fat, 15-20% protein

Patients were followed-up by the same dietitian every two weeks for one year.  All were advised to do aerobic exercise for 30-45 minutes at least three days a week.

Olive oil is traditionally the predominant form of fat in the Mediterranean diet and is a particularly rich source of monounsaturated fat.  At no point in this report was olive oil mentioned, nor any other source of monounsaturated fat.  Until I hear otherwise, I will assume that olive oil was the major source of monounsaturated fat in the TM and LCM diets. 

 All diets were designed to provide 20 calories per kilogram of body weight. 

In all three diets, saturated fat provided 7% of total calories.  Monounsaturated fatty acids provided 23% of total calories in the LCM, and  10% in the other two diets.  Polyunsaturated fatty acids provided 15% of calories in the LCM, and 12% in the other two diets.  The ADA diet provided 15 grams of fiber, the TM had 30 g, and the LCM had 45 g.

Adherence to the assigned diet was assessed with a “food frequency questionnaire” administered at six months.

What Did the Researchers Find?

Average reported energy intake was similar in all three groups: 2,222 calories per day.

Monounsaturated fat intake differences were statistically significant: 14.6, 12.8, and 12.6% for the LCM, TM, and ADA diets, respectively.  Polyunsaturated fat intake differences were statistically significant: 12.9, 11.5, and 11.2% for the LCM, TM, and ADA diets, respectively.

Percentage of energy from carbs was highest for the ADA diet (45.4%), intermediate for the TM diet (45.2%), and lowest for the LCM diet (41.9%).

At the end of 12 months, all three groups lost about the same amount of weight (8-9 kg or 18-20 lb), body mass index, and waist circumference.

Hemoglobin A1c fell in all three groups, but was significantly greater for the LCM group than for the ADA diet (6.3% absolute value vs 6.7%).

Triglycerides fell in all three groups, but was significantly greater for the LCM diet compared to the ADA diet.

The LCM group achieved a significant increase (12%) in HDL cholesterol compared to the ADA diet, but not different from the TM group.

LDL cholesterol fell in all three groups, and the LCM group’s drop (25%) was clearly superior to that of the ADA diet (14%) but about the same as the TM diet (21%).

Conclusions of the Investigators

We found that an intensive community-based dietary intervention reduced cardiovascular risk factors in overweight patients with [type 2 diabetes] for all three diets.  The LCM group had improved cardiovascular risk factors compared to either the ADA or the TM groups.

Only the LCM improved HDL levels and was superior to both the ADA and TM in improving glycaemic control.

It would appear that the low carbohydrate Mediterranean diet should be recommended for overweight diabetic patients.

My Comments

There’s no way the average diabetic could replicate this low-carb Mediterranean diet without working closely with a dietitian or nutritionist.

Any superiority of this low-carb Mediterranean diet may have as much to do with the increased monounsaturated fat intake as with the reduced carb consumption.  Monounsaturated fatty acid consumption is thought to improve insulin sensitivity. 

NutritionData’s Nutrient Search Tool can give you a list of foods high in monounsaturated fat.

The Mediterranean diet and low-carb diets independently have been shown to lower after-meal glucose levels, which probably lowers LDL cholesterol and triglycerides.

I’m disappointed the dietitians were not able to achieve a lower level of carbohydrate consumption in the low-carb Mediterranean diet group.  I suspect if they had, improvements in glucose control and lipids would have been even better.  But proof awaits another day.

We saw last year an article in the Annals of Internal Medicine that showed a dramatic reduction in the need for glucose-lowering drugs in type 2 diabetics following a different low-carb Mediterranean diet over four years, compared to a low-fat American Heart Association diet.  These two studies convince me a low-carb Mediterranean diet has real life-preserving and life-enhancing potential. 

Diabetics looking for a low-carb Mediterranean diet today have several options:

If you’re aware of any other low-carb, explicitly Mediterranean-style diets, please share in the Comments section.

Steve Parker, M.D. 

References: 

Elhayany, A., Lustman, A., Abel, R., Attal-Singer, J., and Vinker, S.  A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 dabetes mellitus:  a 1-year prospective randomized intervention study.  Diabetes, Obesity and Metabolism, 12 (2010): 204-209.

Esposito, Katherine, et al.  Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes.  Annals of Internal Medicine, 151 (2009): 306-314.

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May 15, 2010 · 12:41 AM

R.I.P.: K. Dun Gifford, Mediterranean Diet Advocate

K. Dun Gifford, founder of Oldways, passed away a few days ago.  Read about his interesting life at The Boston Globe.

I have no doubt that Mr. Gifford’s promotion of the healthy Mediterranean diet helped to save lives and improve quality of life for many. 

Steve Parker, M.D.

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May 1, 2010 · 1:36 AM

Mediterranean Month: Health Benefits of the Mediterranean Diet

Oldways, the preeminent promoter of the Mediterranean diet,  proclaims May to be “Mediterranean Month.”  The idea is to spread awareness of the traditional Mediterranean diet. 

In addition to “it just plain tastes good,” I’m a Mediterranean diet advocate because of the potential health benefits.

Relatively strong evidence supports the Mediterranean diet’s association with:

  • increased lifespan
  • lower rates of cardiovascular disease such as heart attacks and strokes
  • lower rates of cancer (prostate, breast, uterus, colon)
  • lower rates of dementia
  • lower incidence of type 2 diabetes

Weaker supporting evidence points to associations with:

  • slowed progression of dementia
  • lower severity of type 2 diabetes, as judged by diabetic drug usage
  • less risk of developing obesity
  • better blood pressure control in the elderly
  • improved weight loss and weight control in type 2 diabetics
  • less risk of metabolic syndrome
  • improved control of asthma
  • lower rates and severity of chronic obstructive pulmonary disease
  • lower risk of gastric (stomach) cancer
  • less risk of macular degeneration
  • less Parkinsons disease
  • increased chance of pregnancy in women undergoing fertility treatment
  • lower incidence of asthma and allergy-like symptoms in children of women who followed the Mediterranean diet while pregnant

For ideas on moving your diet in a Mediterranean direction, why not visit this page at one of my other websites, or the Oldways site?  You don’t have to go “full Mediterranean” to gain some of the health benefits.  Just taking a couple steps in that direction should help. 

Diabetics concerned about the relatively high carbohydrate content in the Mediterranean diet should consider the Low-Carb Mediterranean Diet. 

Also check out Oldways blog, The Oldways Table.

Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physican before making any dietary or exercise changes.

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April 24, 2010 · 8:21 AM

Whole Grains Reduce Heart Attacks and Strokes

Whole grain consumption is associated with a 21% reduction in cardiovascular disease when compared to minimal whole grain intake, according to a 2008 review article in Nutrition, Metabolism, and Cardiovascular Disease.   

Coronary heart disease is the No. 1 killer in the developed world.  Stroke is No. 3.  The term “cardiovascular disease” lumps together heart attacks, strokes, high blood pressure,  and generalized atherosclerosis (hardening of the arteries). 

Investigators at Wake Forest University reviewed seven pertinent studies looking at whole grains and cardiovascular disease.  The studies looked at groups of people, determining their baseline food consumption via questionnaire, and noted disease development over time.  These are called “prospective cohort studies.” 

None of these cohorts was composed purely of diabetics.

The people eating greater amounts of whole grain (average of 2.5 servings a day) had 21% lower risk of cardiovascular disease events compared to those who ate an average of 0.2 servings a day.  Disease events included heart disease, strokes, and fatal cardiovascular disease.  The lower risk was similar in degree whether the focus was on heart disease, stroke, or cardiovascular death.

Note that refined grain consumption was not associated with cardiovascular disease events. 

Why does this matter?

The traditional Mediterranean diet is rich in whole grains, which may help explain why the diet is associated with lower rates of cardiovascular disease.  If we look simply at longevity, however, a recent study found no benefit to the cereal grain component of the Mediterranean diet.  Go figure . . . doesn’t add up. 

Readers here know that over the last four months I’ve been reviewing the nutritional science literature that supports the disease-suppression claims for consumption of fruits, vegetables, and legumes.  I’ve been disappointed.  Fruit and vegetable consumption does not lower risk of cancer overall, nor does it prevent heart disease.  I haven’t found any strong evidence that legumes prevent or treat any disease, or have an effect on longevity.  Why all the literature review?  I’ve been deciding which healthy carbohydrates diabetics and prediabetics should add back into their diets after 8–12 weeks of the Ketogenic Mediterranean Diet.

The study at hand is fairly persuasive that whole grain consumption suppresses heart attacks and strokes and cardiovascular death.  [The paleo diet advocates and anti-gluten folks must be disappointed.]  I nominate whole grains as additional healthy carbs, perhaps the healthiest.

But . . .

. . .  for diabetics, there’s a fly in the ointment: the high carbohydrate content of grains often lead to high spikes in blood sugar.  It’s a pity, since diabetics are prone to develop cardiovascular disease and whole grains could counteract that.  We need a prospective cohort study of whole grain consumption in diabetics.  It’ll be done eventually, but I’m not holding my breath.

[Update June 12, 2010: The aforementioned study has been done in white women with type 2 diabetes.  Whole grain and bran consumption do seem to protect them against overall death and cardiovascular death.  The effect is not strong.]

What’s a guy or gal to do with this information now?

Non-diabetics:  Aim to incorporate two or three servings of whole grain daily into your diet if you want to lower your risk of heart disease and stroke. 

Diabetics:  Several options come to mind:

  1. Eat whatever you want and forget about it [not recommended].
  2. Does coronary heart disease runs in your family?  If so, try to incorporate one or two servings of whole grains daily, noting and addressing effects on your blood sugar one and two hours after consumption.  Eating whole grains alone will generally spike blood sugars higher than if you eat them with fats and protein.  Review acceptable blood sugar levels here.
  3. Regardless of family history, try to eat one or two servings of whole grains a day, noting and addressing effects on your blood sugar.  Then decide if it’s worth it.  Do you have to increase your diabetic drug dosages or add a new drug?  Are you tolerating the drugs?  Can you afford them?    
  4. Assess all your risk factors for developing heart disease: smoking, sedentary lifestyle, high blood pressure, age, high LDL cholesterol, family history, etc.  If you have multiple risk factors, see Option #3.  And modify the risk factors under your control.   
  5. Get your personal physician’s advice.    

Steve Parker, M.D.

Extra Credit:  The study authors suggest a number of reasons—and cite pertinent scientific references—how whole grains might reduce heart disease:

  • improved glucose homeostasis (protection against insulin resistance, less rise in blood sugar after ingestion [compared to refined grains], improved insulin sensitivity or beta-cell function)
  • advantageous blood lipid effects (soluble fiber from whole grains [especially oats] reduces LDL cholesterol, lower amounts of the small LDL particles thought to be particularly damaging to arteries, tendency to raise HDL cholesterol and trigylcerides [seen with insulin resistance in the metabolic syndrome])
  • improved function of the endothelial cells lining the arteries (improved vascular reactivity)

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

Reference: Mellen, P.B, Walsh, T.F., and Herrington, D.M.  Whole grain intake and cardiovascular disease: a meta-analysis.  Nutrition, Metabolism and Cardiovascular Disease, 18 (2008): 283-290.

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Filed under Carbohydrate, coronary heart disease, Diabetes Complications, Grains, ketogenic diet, legumes, Mediterranean Diet, Stroke

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